臺灣博碩士論文加值系統

中文摘要
由於老年人口的增加，長期照護已漸漸受到重視。老人慢性疾病中以
腦中風及心血管疾病居多。許多研究指出同半胱胺酸濃度增加是造成
心血管疾病的獨立危險因子，而且血漿中同半胱胺酸與維生素B6 、B12及葉酸含量呈負相關，然而目前上少有研究探討補充維生素B6、B12及葉酸對長期照護的病人血漿中同半胱胺酸含量以及對氧化傷害和對身體的影響。因此本研究目的是探討補充維生素B12及葉酸對長期照護機構罹患慢性心、腦血管疾病之病患血漿同半胱胺酸含量、氧化傷害程度，以及一般生化值的影響。針對長期照護病患先評估營養狀況後，給予營養介入，參考『國人膳食營養素參考攝取量』（Dietary Reference Intakes），每日供給50歲（含）以上男性熱量1700~2000大卡，女性熱量1500~1800大卡，達三個月後，再由病患個人資料及血液生化檢測值篩選出（1）血漿白蛋白≧3.0g/dl者，（2）50歲（含）以上者，（3）罹患二年以上心、腦血管疾病或引發中風者，三項條件皆具者共21位（男：9人，女：12人），平均年齡75±10歲，每天合併給予葉酸5mg及維生素B12（Mecobalamin 0.5mg）各一粒錠劑，持續補充八週。前後八週補充劑介入結果：血漿葉酸含量給補充劑前後，平均由6 ±2ng/ml遽升為33 ±22ng/ml（p<0.001）；血漿維生素B12濃度給補充劑前後，平均由1142 ±354pg/ml顯著增加為1683 ±731pg/ml（p<0.001）。21位受試者血漿tHcy濃度在給補充劑前後由13 ±3μmol/l顯著降為10 ±2μmol/l(p<0.001），血漿tHcy與血漿葉酸及維生素B12呈負相關（p＝0.016，0.003）。受試者未補充葉酸及維生素B12前，血紅素含量為12 ±2g/dl，補充八週後血紅素顯著上升為12.6 ±2g/dl（p＝0.028），血紅素與血漿維生素B12成正相關（p＝0.027），但與葉酸不具相關性（p＝0.367）。Albumin、CRP ( C-reactive protein)及總抗氧化力( Trolox equivalent antioxidant capacity, TEAC)的含量在給補充劑前後均無顯著差異（p值分別為0.125，0.859和0.681）。丙二醛（malondialdehyde, MDA,為脂質過氧化指標）值由給補充劑前的7±3 µM，顯著降為給補充劑後的3±3 µM （p<0.001）。本研究結論：每天定期補充維生素B12 及葉酸可使長期照護機構中罹患慢性心、腦血管疾病病患的tHcy和MDA濃度顯著下降，但兩者不具相關性（p＝0.3），且補充維生素B12比葉酸明顯亦可使貧血現象獲得改善。

Abstract
The population of the aged is rising rapidly in Taiwan, and its long-term care has become an important issue. Deficiencies in folate and vitamin B12 are indepdent risk factors of cardiovascular and cerebraovascular diseases, which are common ailments of the patients in the long-term care facilities. This study was to evaluate the changes of the blood levels of homocysteine (Hcy) and oxidative damage in patients in long-term care facilities with cardiovascular, and cerebrovascular disease subjects after folic acid and VitB12 supplementation. We included a total of 21 subjects (M：9; F：12; age 75±10) who had cardiovascular and/or cerebrovascular disease and
met the following criteria: (1) albumin≧3.0gm/dl, (2) ≧50 years old, and (3) had lived in long-term care facilities for at least 2 years. Subjects received 1500 Kcal ~ 2000 Kcal (according to Dietary Reference Intakes) every day for 3 months, and were then given folic acid (5 mg) and VitB12 (Mecobalamin 0.5mg) per day for 8 weeks. The results of the folate / VitB12 supplementation showed that the plasma folate ,VitB12 and Hb levels were all significantly increased after eight weeks of supplementation ( p&lt;0.001,0.001,and p＝0.028, respectively). The plasma concentration of VitB12 in patient is positively associated with level of hemoglobin（Hb）( p＝0.027 ), but plasma folate showed no association with Hb ( p＝0.367 ). Levels of tHcy and malondialdehyde were significantly decreased ( p&lt;0.001,and p&lt;0.001,respectively), but tHcy showed no association with to malondialdehyde
( p＝0.3 ), while albumin , CRP ( C-reactive protein) and Trolox equivalent antioxidant capacity were not significantly changed ( p＝0.125,0.859 and 0.681, respectively). In conclusion, folate acid ,VitB12 supplementation in addition to basic caloric intake is desirable for the health of the patients in long-term care facilities.

目錄
摘要
中文摘要……………………………………………………………1
英文摘要……………………………………………………………3
名詞縮寫……………………………………………………………5
壹、文獻回顧
研究背景與動機……………………………………………………6
同半胱胺酸代謝途…………………………………………………10
貳、研究目的………………………………………………………11
參、研究方法
（一）、研究設計 …………………………………………………12
（二）、研究對象………………………………………………… 13
（三）、研究流程………………………………………………… 14
（四）、統計分析方式…………………………………………… 15
（五）、血液及生化檢測法 ………………………………………16
檢測項目………………………………………………………… 16
驗方法及原理…………………………………………………… 17
總同胱胺酸（tHcy）檢測……………………………………… 18
葉酸檢測………………………………………………………… 19
維生素B12檢測……………………………………………………19
丙二醛（MDA）檢測………………………………………………19
總抗氧化力（TEAC）檢測……………………………………… 19
C-反應蛋白（CRP）檢測……………………………………… 20
肆、研究結果……………………………………………………… 21
表1、受試者補充folate及VitB12八週，測定補充前後血漿
中tHcy , folate及VitB12的變化…………………………23
圖1、受試者『給補充劑八週前後血漿同半胱胺酸濃度比較』
………………………………………………………………24
圖2、受試者『給補充劑八週前後血漿葉酸濃度比較』………25
圖3、受試者『給補充劑八週前後血漿維生素B12濃度比較』
……………………………………………………………26
表2、受試者補充folate及VitB12八週，測定補充前後血漿中
MDA、CRP及TCAE變化………………………………………27
表3、受試者補充folate及VitB12八週，測定補充前後血漿中
生化值的變化………………………………………………28
表4、檢測補充劑（folate與VitB12）與tHcy ,Hb相關性……29
表5、檢測tHcy與MDA, TG, TEAC, CRP相關性…………………30
伍、討論…………………………………………………………… 31
陸、結論…………………………………………………………… 35
柒、參考文獻……………………………………………………… 36
附錄一 同意書………………………………………………………40
附錄二21位心、腦血管疾病患者合併症情形…………………… 42
附錄三 受試者營養介入前與給補充劑前後體重變化……………43
附錄四 21位受試者與去除極端值後20位受試者補充folate及
VitB12八週，定補充前後血漿中folate的變化…………44
附錄五 台閩地區長期照護機構歷年成長圖（1995-2001）…… 45
附錄六 近年我國老年人口數一覽表………………………………46
附錄七 台閩地區老人安養護及長期照護資源分布表……………47
附錄八 民國91年國人十大死因……………………………………48
附錄九 導致全世界死亡原因………………………………………49

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